Children’s Mental Health Task Force (CMHTF)
Children’s Mental Health Task Force (CMHTF) is a coalition of pediatricians, child psychiatrists, psychologists, social workers, insurance representatives, policy advocates, various commissioners, legislators, employer groups, nurses, and groups from the education and correctional services community in an effort to improve children’s mental health in Massachusetts. The Task Force has been successful in obtaining reimbursement for non-face-to-face care, increasing payments for child psychiatrists, helping to pass a Children’s Mental Health Bill and monitoring its implementation, facilitating funding for the Parent Advocacy League from HMO’s, and facilitating the creation of various local children’s mental health programs. The Child Psychiatry Access Project has been launched in six regional sites around the state and is enabling pediatricians to get training and consultations in psychopharmacology and managing patients with mental health problems. It has become a national model replicated in other states.
Recent activities include:
- The Massachusetts Child Psychiatry Access Project (MCPAP) now covers 98% of the state of Massachusetts. In FY 2017, MCPAP revised its strategic plan . MCPAP is available to primary care clinicians for timely child behavioral health pediatric consultation and care coordination. Visit MCPAP on the web at www.mcpap.com. For more information please call 617-350-1990. This past year the legislature fully funded MCPAP with contributions from private insurers and expanded MCPAP to provide consultation, referral and treatment for parents screened positive for perinatal depression., MCPAP for MOMS.
- The Task Force continues to advise the CBHI on implementation and Medicaid payment reform by serving as the MCAAP’s representative on the advisory board and providing ongoing advice on pediatric behavioral health including payment for pediatric screening including modifications to the birth-6 month measures, adding the EPDS, SWYC and other assessments to approved screens and planning to implement on 7/1/15 universal parental post partum depression screens in the first 6 months of life. The Task Force also serves as the Academy’s representative on the advisory board established legislatively by the Children’s Mental Health Bill which became law this past summer. The Task Force continues to monitor and advocate for full implementation of this legislation particularly in light of budget cuts and their impact on early intervention services and child mental health services. Most current discussion centers on the implementation of Chapter 224 and global payment emphasizing the integration of behavioral health in the pediatric medical home.
- The Task Force is actively engaged with the MCAAP Executive Board and coordinated an Early Childhood Summit meeting in the fall of 2011 with co-sponsors from Strategies for Children Inc. (Early Education For All Campaign), the Boston Children’s Museum, and the Mass Society for the Prevention of Cruelty to Children. A second summit in April 2013 was held at the Federal Reserve Bank of Boston with the Boston Childrens Museum as the lead sponsor and included a new co sponsor, the Center on the Developing Child at Harvard University. That summit focused on the mitigation of toxic stress with innovative approaches to supporting parenting and preschool education. We have also made a major effort to engage the local business community. Plans are now in place to bring together over 80 organizations engaged in the birth to eight space in the city of Boston to create a collective impact policy agenda with concrete actionable outcomes. Three meetings have been held with support from the Boston Opportunity Agenda, United Way and the Boston Children’s Museum.
The Task Force has formed a working group on defining quality behavioral health outcomes. Chair: Barry Sarvet M.D. email:Barry.Sarvet@baystatehealth.org. This group is in the final stages of issuing a report outlining 5 domains of quality outcomes: symptoms, functioning, connections, resiliency and services. The domains are meant to include detailed constructs which should inform the development of specific measures so that quality behavioral health outcomes can be measured and protected in the face of health reform and global payment.
This year, major efforts have gone into advocating and implementing postpartum depression screening in the first year of life as part of buffering toxic stress. We are working closely with private payers, MCPAP, DPH, MassHealth and CBHI to include the PPD screen both as an isolated instrument and as part of a new comprehensive screen (the SWYC) developed by Ellen Perrin which now has published validation data. We continue to emphasize the need for treatment to focus not just on mothers but on families including parent infant interaction. MCPAP and Dr. Yogman have given pediatric grand rounds all over the state to train and promote universal PPD screening by pediatricians at 1, 2, 4 and 6 month well visits.
Finally, several new issues were addressed by the task force this year:
1) the changing epidemiology of pediatric practice with behavioral health concerns displacing asthma and infectious disease as the top 5 reasons for pediatric office/er visits
2) innovative models for behavioral health integration in pediatric practice including care coordination but requiring new payment models for sustainability: the task force convened a working group with the pediatric council of providers, payers, contracting entities and policy makers to discuss models of sustainability. The task force met with the Alliance for Integrated Mental Health and supported a spring meeting to share best practices in this area.Promoted new certificate program at William James College to provide training/certificate for behavioral health providers working in integrated settings
3) enhanced screening and treatment for teenage substance abuse using the NIDA screen and new SBIRT intervention models (Dr Sarah Pitts)
4) implications of new parity regulations 7/1/14
5) new parent survey data by PPALS
6) needs for medical consultation to DCF and advice by child advocate; discussion of current science regarding abusive head trauma, concerns about the pediatric expertise in the ME office
7) ongoing concerns about kids stuck in ER’s awaiting in patient mental health beds;discussed implementation of new boarding study
8) ongoing preschool expulsions : the task force heard from Comm Tom Weber of EEC and submitted recommendations to him for improving mental health consultation to child care providers; continued updates in this area both nationally and locally were provided including the scarcity of mental health consultation to child care providers;continued discussions and collaboration with Dept EEC to enhance mental health consultation to child care providers and prevent preschool expulsion
9) integration of home visiting into the medical home and
10) innovative new programs for engaging non residential fathers with children (fathers uplift).
11) update from MCPAP for MOMS on pediatric training on postpartum depression screening;discussed need for screening fathers for PPD
12) Social emotional learning: update on enhanced curricula for social emotional learning in both public schools and preschools
13) Mass Child Health Quality Coalition : update from Karen Smith on CHIPRA quality measures
14) Reviewed outcome data from Boston Public Health Commission from Project Launch/ My Child;needs for early child mental health workforce
15) Problems of timely communication between behavioral health providers and pediatric PCP’s were examined; HIPPA regulations both federal and state were clarified and efforts are underway to share essential information in a more timely way;Comm Mikula is reviewing our recommendation
16) Wait times for outpatient behavior health appointments were again assessed as was network adequacy
17) The newly appointed child advocate, Maria Mossaides, presented her goals for the office to the task force
18) Maternal child health transformation plans were presented involving more emphasis on social emotional development and enhanced eligibility for early intervention in this domain
19) Earlier identification of autism and better access to ABA services were examined.
20) update from Dr Linda Sagor, CMO of DCF on enhanced quality
21) discussed need for early identification of childhood psychosis and potential need for screening
22) presented new model of parenting dissemination called Boston Basics;further presentation of this program next fall
23) continued work on quality outcomes project led by Barry Sarvet
We have had good success this year in recruiting and expanding participation by pediatricians in the Task Force. We welcome new members and can make participation available by conference call.
If people have questions about any of this or wish to join the CMHTF, they can email me at firstname.lastname@example.org.
Chair – Dr. Michael Yogman
RECENT ARTICLE BY CMHTF MEMBER – Howard King, M.D.